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PE requires that patients overcome their natural tendency to avoid thinking and talking about the traumas that they experienced. The challenge for patients is the fact that avoidance has been the primary strategy they have used to cope with their trauma-related distress. Many of the procedures incorporated into the PE program, including the structure imposed by using a manualized treatment, provide a foundation for encouraging clients to overcome their avoidance in order to experience the exposure exercises. In addition to specific aspects of the PE program, numerous nonspecific factors can facilitate treatment. Basic therapeutic skills, such as empathy and active listening, are invaluable. Perhaps most important is the therapist's ability to convey confidence in the effectiveness of the therapy the client's ability to complete the treatment program, and expertise in conducting the treatment.
Establishing a relationship or rapport, e.g. learning more about patient's worries and concerns and making patient feel comfortable by giving and asking information not interrupting too much or looking at notes needs awareness of verbal and non-verbal communication and ability to engage in active listening
A strong, collaborative, therapeutic relationship is essential to help clients overcome these hurdles. Therapists must utilize their basic clinical skills, particularly empathic, active listening, to foster such a relationship. Furthermore, specific aspects of the PE protocol, such as ensuring the client's understanding of what is being done and why by explaining the techniques and sharing the rationale for each one, are designed to further this collaborative relationship. Beyond simply needing a collaborative relationship in which to conduct PE, the treatment requires joint decision making by the therapist and client about treatment focus, pace, and homework assignments. Helping the client to be and feel in control of this process is imperative and can itself be therapeutic, because many clients with PTSD feel out of control of most of their lives even (or especially) their own thoughts, feelings, and behavior. In addition to facilitating a collaborative relationship in the treatment...
It is useful to first engage the family in building a family tree, as shown in Fig. 1. The family tree or genogram gives us a diagram of the family usually over three generations. In compiling the family tree, the clinician and family begin to develop a relationship which will be the foundation for further work. Communication skills such as active listening are the basis for compiling the history of the family and the sharing of the worries and concerns which are stirred up by the diagnosis of a life-threatening illness. The family tree can also be useful in helping families talk about the way they coped before the patient became ill. The history of illness and loss is laid out for everybody to see. Sometimes families then perceive patterns which they had not recognised before.